Jeffcoate W J, Silverstone J T, Edwards C R, Besser G M
Q J Med. 1979 Jul;48(191):465-72.
The incidence of psychiatric abnormalities has been assessed in 38 patients with Cushing's syndrome and two with alcohol-induced pseudo-Cushing's syndrome. Twenty-six patients were examined by one of us using a standardized psychiatric interview, and this group included all those with severe to moderate psychiatric disorders. Depression was the commonest symptom: five patients (13%) were markedly or severely depressed, four (10%) were moderately depressed and 13 (32%) were mildly depressed. Four patients exhibited other, non-depressive psychiatric symptoms and only 14 (35%) were judged free from psychiatric abnormality. The first line of treatment was to reduce the circulating cortisol level either by adrenalectomy or by treatment with oral metyrapone; both patients with alcohol-induced pseudo-Cushing's syndrome were treated by alcohol withdrawal. Once the plasma cortisol level was successfully controlled, depressive symptoms were relieved in all five patients with marked or severe depression and in three of the four who were moderately depressed. Mild depressive symptoms were relieved in six of the 13 affected. It is concluded that metyrapone may be of considerable value in the management of the acute psychiatric states which may occur in Cushing's syndrome and these findings are discussed in the light of their possible pathogenesis.
我们对38例库欣综合征患者和2例酒精性假性库欣综合征患者的精神异常发生率进行了评估。我们中的一人使用标准化精神科访谈对26例患者进行了检查，该组包括所有患有重度至中度精神障碍的患者。抑郁是最常见的症状：5例患者（13%）明显或重度抑郁，4例（10%）中度抑郁，13例（32%）轻度抑郁。4例患者表现出其他非抑郁性精神症状，只有14例（35%）被判定无精神异常。一线治疗是通过肾上腺切除术或口服甲吡酮治疗来降低循环皮质醇水平；2例酒精性假性库欣综合征患者通过戒酒进行治疗。一旦血浆皮质醇水平得到成功控制，所有5例明显或重度抑郁的患者以及4例中度抑郁患者中的3例的抑郁症状得到缓解。13例受影响患者中有6例的轻度抑郁症状得到缓解。结论是，甲吡酮在治疗库欣综合征可能出现的急性精神状态方面可能具有相当大的价值，并根据其可能的发病机制对这些发现进行了讨论。
